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This paper examines why Congress’s first major program for comprehensive health care to needy children took five years to begin even partial operation. An examination of the 1967 program’s legislative history reveals that Congress paid little attention to EPSDT’s implications: it was left ambiguous whether health (Title V) or welfare (Title XIX) would administer; costs were never clearly stated; eligibility and scope of services to be provided were left vague. Despite pressure from welfare rights interest groups, these ambiguities delayed the preparation of regulation and guidelines which never did succeed in resolving the question of overlapping jurisdiction and costs. In addition, many states’ resistance to paying for the program further held up implementation. The paper concludes that: (1) Congress’s and HEW’s unwillingness to face up to the real costs of health programs threatens long-term public and state support for such programs; (2) division of responsibility between health and welfare lessens the impact of a program; (3) grant-in-aid programs give states the power to distort the intent of federal health policies; and (4) where states fail to implement such policies, initiatives may pass to consumer advocacy groups.
Author(s): Anne-Marie Foltz
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Volume 53, Issue 1 (pages 35–64) Published in 1975
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.